Laboratory assessment of thrombolytic therapy in acute myocardial infarction

Area of Science:

• Cardiology
• Hematology
• Thrombosis Research

Background:

• Acute myocardial infarction (AMI) treatment aims to restore blood flow and minimize cardiac damage.
• Thrombolytic therapy is crucial for AMI, with streptokinase (SK) and recombinant tissue plasminogen activator (rt-PA) being common agents.
• Understanding hemostatic profiles and cardiac enzyme changes is vital for assessing treatment efficacy and safety.

Purpose of the Study:

• To compare the hemostatic profiles and cardiac enzyme changes in acute myocardial infarction (AMI) patients treated with SK and rt-PA.
• To evaluate the incidence of bleeding and vessel occlusion associated with SK and rt-PA therapies.
• To assess the impact of these therapies on reperfusion and mortality rates.

Main Methods:

• A study involving 55 acute myocardial infarction (AMI) patients.
• Analysis of hemostatic profiles, including fibrinogen, FDP, and D-Dimer levels.
• Monitoring of cardiac enzymes (CK, CK-MB) to assess reperfusion.
• Comparison of bleeding incidence and vessel occlusion rates across different treatment groups (conventional, SK, rt-PA) with varying anticoagulant and antiplatelet regimens.

Main Results:

• Hypofibrinogenemia was observed in 85% of the SK group and 55% in the rt-PA group, with elevated FDP and D-Dimer indicating fibrinogenolysis and clot lysis.
• Bleeding incidence was similar between SK and rt-PA groups when combined with anticoagulants, but lower in the rt-PA with antiplatelet group.
• Mean FDP levels were significantly higher in patients experiencing bleeding (p < 0.01).
• Peak CK and CK-MB values indicated reperfusion rates of 26.6% (conventional), 60% (SK), and 90% (rt-PA).
• No early or late occlusions occurred with SK or rt-PA plus anticoagulants; however, late occlusion was noted with rt-PA plus antiplatelet.
• Mortality rate was 20% in the conventional therapy group.

Conclusions:

• Both SK and rt-PA therapies induce hypofibrinogenemia and systemic fibrinogenolysis in AMI patients.
• rt-PA demonstrates superior reperfusion rates and potentially lower risks of late occlusion when used with antiplatelet agents compared to SK.
• While bleeding risks are comparable with anticoagulants, rt-PA with antiplatelet therapy may offer a better safety profile regarding vessel patency.